UW 24 Flashcards by Gaby Matamoros

Wells criteria for pulmonary embolism (7)

3 points:
DVT
Other diagnosis less likely

1.5 points:
Tachycardia
Recent surgery/bed ridden
Hx of DVT

1 point
Malignancy (hypercoagulability)
Hemoptisis

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Pancreatitis due to biliary stone surgical management

If sings of obstruction: ERCP

If medical management was succesfull: elective cholecistectomy

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HIDA indication (hepatobiliary iminodiacetic acid)

Tracer for biliary secretion

Used when diagnosis is not clear with ultrasound.

If gallbladder can not be visualized it meas obstruction.

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What causes butulism infants vs. adults

Infants: bacteria colonization that produces the toxin (spores)
Adults: preformed toxin

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Clinical presentation of infant botulism

<12 months

First: Poor feeding, constipation, hypotonia

Oculobulbar palsy: midirasis, ptosis, absence of gag reflex,

Symmetric descending paralysis

Autonomic dysfunction: decreased salivation, fluctuating HR

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Empiric ATB treatment for patients with splenectomy

Amoxicilin-clavulanic

Levofloxacin for penicillin allergic patients

TMP-SMX also have similar spectrum but its not used due to delay batericidal effect and resistance

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Pinealoma

Parinaud sd:
Limited upwasrd gaze
Lid retraction
Pupil react to accomodation but not to light

Obstructive hydrocephalus
Papilledema, vomiting ataxia

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Brain tumor in children

Craneopharingioma: most common supracellar. Optic chiasm compresion (bitemporal hemianopsia). Craneo, Cystic, Calcifications

Astrocytoma: Posterior fossa/infratentorial. Symptoms of intracraneal pressure

Medulloblastoma: arises from the cerebellar vermis or fourth ventricle. Presents with ataxia. Highly malignant but responds to radiation. Drop metastasis to central cord

Pinealoma: Parinaud sd and obstructive hydrocephalus

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Pertusis presentation

Common in infants but DO NOT exclude adults with paroxysm of cough

Catharral: URI symptoms for 1-2 weeks
Paroxysmal: cough can last for 2-3 months
Convalescent: symptoms wane

Labs: leukocytosis with lymphocytosis

Treat with macrolides and close contacts too

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Side effect of calcineurin inhibitors

Cyclosporin and tracolimus (via IL-2 inhibition)

Vasoconstriction (renal), hypertension

Prerenal acute kidney injury

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Otitis media common organisms in children <2 yoa

S. pneumonia
S. pyogenes
S. aureus

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Otocholestoma presentation

Recurrent painless otorrhea

Perly white mass or retraction pocket in the superior portion of the timpanic membrane

Associated with recurrent Otitis media

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Post partum urinary incontinance

Stress incontinance

Due to weakness of the pelvic floor and streching of the pudendal nerve

Normal up to 6 weeks after birth

Reassurance +/- kegel exercise

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Lead poisoning antidote

Oral succiner
EDTA
Dimecarpol

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Specific contraindications of pregestin and copper IUD

Copper: Wilson

Progestin: breast cancer, active liver disease

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Suprascapular nerve entrapment

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Shoulder pain
Weak abduction (supraspenitatus)
Weak external rotation (Infraspinatus)

Crossing of the arm may produce scapular pain

Common due to backpack compression

Erlichiosis

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Rocky mountain spoted fever without the spots

Tick vector (lone star), south east and south central USA

Flu like symptoms (fever, myalgias, chills)
Neurologic symptoms
Rash uncommon (,30%)

Leukopenia and thrombocytopenia
LFTs and LDH elevated
Intracytoplasmatic morula in monocytes (MEGA berry: monocytes erlichia, graulocytes anaplasma)
PCR for erlichia

Treatment:
Empiric doxy

What other screen do you do in a patient with Irritable bowel sd

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If its IBS - D, then screen for celiac

If it is constipation predominate, just clinical diagnosis

Calprotectin use

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To diagnose inflamatory diarrhea (infectious , inflamatory bowel disease)

Mononucleosis EBV vs. CMV

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CMV is usually milder (pharyngitis, lyphadenopaties) Hepatosplenomegaly may or may not be preset
Presence of atypical lymphocyte
Negative monopost test

Positive CMV PCR

Defect in Duchene and Beker muscular dystrophy

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Distrophin

Presents at age 2-3

Axial and proximal muscle weakness

EMG: polyphasic potentials and increased recruitment

Defect in Marfan sd

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Fibrilin

Defect in achondroplasia

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Fibroblast growth factor receptor 3

Defect in osteogenesis imperfecta

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Colagen I

Causes of Galactorrhea

Pregnancy Hyperprolactinemia Hypothyroidsm Chest wall, nipple estimulation (trauma, shingles, surgery) Medication (antipsychotics, antidepresants)

Hyperthrophic pulmonary osteoarthropathy

Digital clubbing is accompanied by arthropathy (pain,) that is a attributable to a pulmonary condition like cancer, tb or emphysema

Trauma patients evaluation

ABC FAST, Chest Xray and pelvic xrays, and cervical spine i

When is a cervical spine imaging study indicated in a trauma patient

High energy impact (car crash or fall > 3mts (10ft) ``` or Altered mental status Spinal tenderness Neurologic deficit Intoxication Distracting injury ``` (basically the same is true for any other segment of the spine)

Patient with a cervical fracture on imaging: next step

Complete spine imaging One vertebra fracture in a patient with blunt trauma is indication for the entire spine

Management of TCAs overdose

Supportive ABCs Activated charcoal if <2hr of ingestion NaHCO3 for QRS widening or arrhythmia (TCAs bind to Na channels in Purkinje system and myocardioum causing >100 QRS and hypotension)

Effect of TCAs on heart (patophysiology)

TCAs bind to Na channels in Purkinje system and myocardioum causing >100 QRS and hypotension) Sodium bicarbonate increases pH and inhibits TCAs from binding to Na channels

Aspirin intoxication management

Sodium bicarbonate alkalinizes urine and helps with excretion

Tumor associated with molar pregnancy

Teca lutein cyst

Erythema nodoso Etiology Pathologic findings Evolution

Sarcoidosis Inflamatory bowel disease Medication (antibiotics, OCPs) S. pyogenes infection Septal paniculitis without vasculitis Natural regresion Residual hyperpigmentation

Salmonella no typhi vs. typhoideal

Non typhoideal; Vomit, diarrhea +/- blood, fever Poultry or non refrigerated food

Rash of dermatomyocytis

Violaceous periorbital rash Shawal rash: rash involving the shoulder, upper chest and back Gottron papules: papular rash with scales on the dorsa of the hands, over bony prominences

Urine low specific gravity cut off

<1.006

Suspected polyuria

Complete 24hr urine colection: <3 L: not true polyuria >3 L: ...Diluted: Diabetes insipidus, polydipsia ... Concentrated: osmotic diuresis (DM, urea, saline) DI can present with normal or elevated Na

Anysocytosis and RBW

Anysocytosis is the presence of RBC with multiple size and RBW is the quantification of that

UW 24 Flashcards

(39 cards)